Nov 12, 2014

Dr. Jones: The pill. Birth control day is November 12. A little history, a little information, and where we are going about contraception. This is Dr. Kirtly Jones from the Department of Obstetrics and Gynecology at University of Utah Health Care and this is The Scope.

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Dr. Jones: Whatever you think personally, the vast majority of women have had a moment, maybe a day, maybe a year, maybe a lifetime, when they didn't want to get pregnant. Throughout recorded history, women have tried all kinds of potions, positions, and procedures in an effort not to become pregnant. Some were a little bit helpful, some were really harmful, and some were just ridiculous. Barrier methods like condoms and diaphragms, methods used at the time of intercourse to block sperm from getting up to the egg, have been around for a long time, but using a method of birth control when you aren't really thinking clearly isn't so successful. IUDs have been around for a while but not in their current form.

In 1960, after years of animal and human trials, the hormonal birth control pill was available to women. The doses were high, about five times higher than current doses, the side effects were significant, and women were desperate to take the pill. The inventors created a birth control pill that would block ovulation but give women a monthly period. The monthly period was so women would know they weren't pregnant. Home pregnancy tests weren't available then. It was also formulated in the hope that the Pope would think it was natural and allow Catholic women to use it. Well, that didn't work so well, but Catholic women took the pill anyway, and it worked if you took it regularly.

But now, we are way beyond the pill for birth control. We know more and we have more choices. In thinking about birth control, some women think about effectiveness. Some women think about side effects and risks. Some women think about costs, and for some women, how it works matters to them, and women like me think about all those things. So, let's talk about birth control methods starting with what's most important to me, which is effectiveness.

Effectiveness is often presented in terms of the chances of getting pregnant in one year using a given method. There's a problem here. Women using birth control for many years, maybe up to 30 years, so methods that might have a chance of getting pregnant, so-called failure rate, of 10% per year will have a very high cumulative chance of getting pregnant over 10 years. Also, effectiveness or failure rate of methods often depends on the woman doing something. If she doesn't do it or do it correctly, it won't work. The method might be very good in theory but not so good in practice.

So, methods that work well and you don't have to think about include blocking a woman's tubes or a man's tubes, but this is permanent. The lifetime failure rate, lifetime, 30 years, of tubal ligation or vasectomy might be about 1%, not per year, but for lifetime, but it's not reversible and some people just don't want to have a baby now, but they'd like to have one later or at least keep their options open.

Methods that rarely fail that you don't have to think about and that are reversible include the IUD, one type with hormones, one type with copper, and implants that go under the skin in your arm, and that has hormones. They work from 3 to 10 years, depending on which one you choose, and are easy to remove. They have a failure rate of about 1%, one in a hundred, or less per five years of use, so that makes a pretty low failure rate.

Methods that are pretty good. Failure rate of 5 to 10% per year includes pills, patches, rings, shots. They all have hormones. They have some good things. They decrease menstrual flow. You can choose when to have your periods. They may decrease the risk of ovarian and uterine cancer, but you have to do something and sometimes women don't do those things. They don't take their pills. They don't remember to put their patch on. They forget to get their shot. So, the failure rate's up there in the 5 to 10% per year, and if you're thinking about not wanting a baby for 5 or 10 years, those little 5% add up.

>Methods that aren't so good but are better than nothing and might protect against sexually transmitted infections include male and female condoms, diaphragms, and cervical caps, along with vaginal gels and creams. Failure rates are about 10 to 30% depending on how you use them. If you use them exactly as you should, which is just when you're going to have sex, each time and every time, they work better, but human beings are human beings and each time and every time sometimes turns out to be some of the time.

Methods that don't use hormones or devices but use the timing of sex to avoid the fertile period can work very well. These are called abstinence-based methods. Both people have to agree to follow the rules, and you absolutely cannot break the rules or you'll get pregnant. This means abstaining from sex during your fertile period and being very self-aware about when your fertile period actually is. So, you have to follow the rules. If you follow the rules completely, the failure rate's 1 to 5% per year. If you follow the rules the way most folks follow the rules, the failure rate is 30% per year. There's a little joke. What do you call people who use abstinence-based methods? You call them parents.

So, there are going to be some new birth control methods coming up in the next five years, but they will fall into these groups. Highly effective, reversible, that you don't have to think about, like IUDs and implants, hormonal methods that you have to think about, and barrier methods. Birth control is highly personal. Though it seems as if some folks want to get into your business and into your bedroom, but you should be informed. Today we talked about chances of your birth control working for you, and you shouldn't take chances when it comes to making a baby. Stay tuned. We'll be talking about side effects, how methods work, and costs later on on The Scope.

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